Anyone look into "concierge" doctors

[fastupslowdown]

I always get good feedback here.

My doctor decided to switch to concierge. I like him. Fee is $5k a year to be a member(Ouch!). Besides the $5k what's the downside? I'm not sure but it sounds like any insurance coverage is now out of network another cost. Is that correct?

Anyone have any experience? Am I right about the higher co-pays and coverage now being out of network? -Mike G

[vertical_doug]

There is not one model. You should really speak to the practice and get all the details. You can then follow-up with your insurance carrier.

At 5k, he is the lower end. Also, this is usually only for Primary Care and any specialized treatment will bring you back into referrals. You will want to know how that works too.

[Too Tall]

We should talk off line. I've got an highly skilled GP for the last 20 yrs. His skill, dedication and referrals are why I stick with him when the practice went private. The main reason is continued access to my doc. and supporting his need for a manageable practice not as encumbered by insurance oversight.

Co-pays remain all the same since nearly all referrals are in network. My yearly physical is where it bites becuase my doc. does not adhere to my insurance requirements...but it's not so bad ;)

Helps?

[htwoopup]

I did this with my doc for a few years until he retired. He did it while grouping with a bunch of others so that odds were there was still a specialist for my needs. They somehow priced that into the single concierge annual fee. Back then (maybe 10ish years ago) he charged me 5 per year in Manhattan which included the other guys too. I got a sort of catastrophe insurance because my fear was the hospital and all of those types of facilities and docs/ services there if needed. I am not sure that it saved me much money overall nor did it cost more (although I had no major hospital etc needs over that time). I just really liked and trusted that doc and he was in a group with like minded/ like personality other docs. After he retired I went back to the usual US method of insurance with its fights and copays because I couldn’t find a similar situation.

[j44ke]

We signed onto two different specialists who managed their practices this way, because their area of expertise was specifically focused on conditions in our family and not replaceable with more of a generalist in those areas. After assurances otherwise, our insurance backed out on coverage.

[bigbill]

My sister and her husband have a concierge doctor, and I believe they are guaranteed same-day visits Monday through Friday. She and her husband got their Covid vaccines four months before me, even though I was at high risk for auto-immune disease and in the first round at VA. You can do things like that if you have lots of disposable income. Her personal physician also tells her it's okay to have cholesterol over 300 because "everything else looks good." I'm in the VA system, but since I'm in a rural area, VA quickly farms me out to local specialists instead of driving 2-3 hours to a VA hospital.

[jclay]

Because specialist referrals are made for most anything of consequence, I require neither unscheduled nor excessive visits, and there are lots of good MDs around here, I didn't see the point; I wasn't going to pay an extra 2k (7 yrs ago) for the privilege. I've had two GPs since leaving my old one seven years ago (trivial hassle) and while unqualified to render medical judgement both were/are sharp, professional, gave rational information, seemed very competent and every bit as capable and knowledgeable as the guy who been both my GP and occupational medical doctor for close to 20 years; and both are much younger, female.

I also won't support further Balkanization of our HC system.

[jclay]

A bit of thread drift but an interesting, tangentially related article: It contradicts (without attribution or data) the economic analyses between private health insurance and social health insurance schemes I’ve read over the years (indicating SHI being more cost effective) while introducing (to me anyway) the concept of revenue financing. It doesn’t build any sort of QED case for revenue financing but it provided additional perspective (revenue financing) and a variety of interesting, if not always surprising (i.e. related military recruitment inducements) comments.

https://www.nakedcapitalism.com/2023...insurance.html

[bigbill]

I read the link, and there's more research to be done. I'm not sure the main driver for military recruiting is free healthcare. The VA system is for Veterans with service-related conditions, not the person who did four years and got out with no long-term issues. VA has large hospitals which serve Veterans in the VA system in large metropolitan areas. I live more than two hours from the closest VA hospital (Las Vegas), so VA has Community Care that uses area doctors. I see a rheumatologist and an oncologist that are about an hour away. The VA is better than it was ten years ago but still has limitations and bottlenecks. Two main groups are using VA, the Vietnam era Vets and the Post 9/11. Each has different expectations, with the Post 9/11 Vets desiring more online resources and telemedicine. The Vietnam Vets want to sit down with a doctor for every appointment. I'm fine with telemed, which labs usually precede so that we can discuss my overall health.

Replacing our healthcare system with Revenue Based or with a VA-type system still requires private healthcare companies with little in the way of price controls. Each specialist I see knows exactly what VA will pay for, so after each initial visit, I usually have a battery of tests that are expensive (if I were paying for them).